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Foundations II (Jess) > Mouth and Throat > Flashcards

Mouth and Throat Flashcards

1
Q

Main etiologies of acute pharyngitis? What percent receive abx?

A

Viral: 50%
Group A strep: 5-15%
Other: allergies, smokers

60% receive abx

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2
Q

Sx of acute pharyngitis

A 
sore throat
fever
HA
malaise
"swollen glands"
URI sx
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3
Q

PE findings of acute pharyngitis

A
  • pharyngeal erythema
  • tonsillar hypertrophy
  • purulent exudate
  • tender anterior cervical lymph nodes
  • palatal petechiae
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4
Q

What do you do in diagnosing acute pharyngitis? (Need to exclude?)

A

Exclude GABHA pharyngitis

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5
Q

Tx of acute pharyngitis

A

supportive tx

reassess if no improvement in 5-7 days or if worsens

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6
Q

Clinical presentation of GABHS

A 
sudden onset ST
tonsillar exudate
tender cervical adenitits
fever
cough ABSENT
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7
Q

Centor criteria:

what are the guidelines

A

0-1: not likely
2-3: need to do Rapid strep test or culture
4: treat with abx

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8
Q

What does a negative RADT mean?

A

does not indicate negative for strep, need to follow-up with culture

not very sensitive (70-90%)

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9
Q

How do you treat GABHS?

A

Penicillin V 500 mg PO TID- TID x 10 days

  • Amoxicillin 500 mg BID x 10 days*
  • penicillin G benzathine 1.2 million unitis IM single dose
  • Cephalexin 500 mg PO BID x 10 days
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10
Q

How can you treat a patient with GABHS who is allergic to penicillin?

A

Macrolides- (erythromycin, clarithromycin, Azithromycin)

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11
Q

Complications of GABHS

A

Acute rheumatic fever
acute glomerulonephritis

others:
Scarlet fever
peritonsillar abscess
OM
mastoiditis 
bacteremia
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12
Q

Based on Paradise Criteria for Tonsillectomy, who is a good candidate for tonsillectomy?

A

Pt w/ at least 7 episodes in the last year or at least 5 episodes in each of the past 2 years or 3 episodes in each of the past 3 years

ST plus fever >100.9 or tonsillar exudate or anterior cervical adenopathy or culture confirmed GABHS

Appropriate abx tx for strep episodes

recommend 12 month obs period

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13
Q

Most common deep neck infection in children/adolescents?

A

peritonsillar abscess

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14
Q

Predominent species in peritonsillar abscess

A

Streptococcus pyogenes (GABHS)

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15
Q

Sx of peritonsillar abscess

A

severe sore throat
fever
“hot potato” or muffled voice

drooling
trismus
neck swelling/pain
ipsilateral ear pain
decrease PO intake
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16
Q

PE findings in peritonsillar abscess

A
  • swollen, fluctuant tonsil w/ deviation of uvula to the opposite side
  • fullness/bulging of posterior soft palate
  • cervical LAD
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17
Q

How do you dx peritonsillar abscess?

A

clinical!

labs you can check:

  • cbc
  • electrolytes
  • throat culture
  • culture of abscess

imaging:
-CT w/ IV contrast

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18
Q

Tx of peritonsillar

A
  • monitor for airway obstruction
  • drainage

-antimicrobial therapy:
parenteral ampicillin-sulbactam or clindamycin
oral: amoxicillin-clavulanate or clindamycin x 14 days

-supportive care

+/- hospitalization

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19
Q

Infectious cause of laryngitis?

A

Respiratory viruses!
rhinovirus, influenza, parainfluenza

Others:
bacterial
noninfectious cause (vocal abuse, GERD)

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20
Q

Main complaint in laryngitis

A

Hoarseness

URI sx- rhinorrhea, congestion, cough, ST

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21
Q

Tx of laryngitis, length?

A

treat underlying cause
(humidification, voice rest including no whispering, hydration, avoid smoking)

usually resolves in 1-3 weeks

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22
Q

Most common cause of epiglottitis? who is at risk?

A

Haemophilus influenza type B

strep
S. aureus

incomplete or non vaccinated
immunodeficiency

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23
Q

3 D’s of epiglottitis? Others?

A

dysphasia, distress, drooling

"tripod" or "sniffing" position
fever
respiratory distress
odynophagia- pain out of proportion
muffled speech
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24
Q

If a pt develops anxiety when trying to visualize epiglottitis what do you do?

A

Stop!
risk of airway obstruction
make sure you are able to intubate if needed

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25
Q

What is the classic sign seen on lateral plain radiograph in epiglottitis?

A

“thumb sign”

26
Q

Tx of epiglottitis? Prevention?

A

medical emergency
airway protection
hospitalization
IV abx- 3rd gen cephalosporin & antistaphylococcal (vancomycin)

Prevention= immunization

27
Q

Clinical presentation of HSV? How long does it last?

A

sudden onset of multiple vestibular lesions on inflamed, erythematous base

10-14 days initial
5 day recurrent

28
Q

What are triggers of HSV?

A 
sunlight
fever
menstruation
stress
trauma
29
Q

How do you dx HSV?

A

clinical

viral culture
serology
immunofluorescence microscopy for antigens

30
Q

How do you treat HSV?

A

antivirals
analgesics
fluid management

31
Q

When do you see herpetic gingivostomatitis? What is it?

A

in Primary HSV infection

ulcerative lesions of gingiva and mucus membrane of mouth often w/ personal vesicular lesions

32
Q

What is coxsackie virus? (other name, common population, etiology, sx, dx/tx)

A

Hand foot and mouth
common in children

coxsackie A16

  • prodrome: low-grade fever, malaise, abd pain, URI sx
  • painful oral lesions- PAPULES on erythematous base

dx/tx:
clinical
supportive care

33
Q

How do you distinguish Hand foot mouth from Herpangia?

A

Hand foot mouth:

  • low grade fever
  • papules on tongue and hard palate

Herpangia:

  • higher fever
  • lesions more posterior (soft palate)
34
Q

Aphthous ulcers: associated with?

A

HHV-6

also seen in celiac dz, IBD, HIV

35
Q

Where are aphthous ulcers found? how do you describe them?

A

gums, tongue, lips, palate, buccal mucosa

painful, small, shallow, round ulcers with gray base surrounded by red halo

36
Q

What are aphthous ulcers triggered by? How do you treat?

A

triggered by stress

topical corticosteroids in adhesive base
topical analgesics

37
Q

What is Bechet’s? How do pt’s present?

Dx/Tx?

A

inflammatory disorder

recurrent oral and genital aphthae

Dx: recurrent oral ulcers > 3 x per year + other clinical findings (eye lesions or skin lesions)

Tx: refer to rheumatologist

38
Q

Who are classic patients with oral candidiasis?

A

infants and older adults (dentures)

39
Q

Risk factors for oral candidiasis

A 
dentures
poor oral hygiene
DM
anemia
corticosteroid use
abx use
HIV
40
Q

Presentation of oral candidiasis?

Important question to ask?

A

painful, creamy-white, curd-like patches over erythematous mucosa
cotton mouth

does it brush off? “Thrush will brush”!

41
Q

If unsure if pt has oral candidiasis, what do you do?

A

normally clinical, but can do KOH wet prep (looking for budding yeast)

42
Q

Tx of oral candidiasis?

A

antifungal- start with topical

  • clotrimazole troches
  • nystatin mouth rinses
43
Q

What is Oral Lichen planus? How does it present?

How do you dx/tx?

A

chronic, inflammatory autoimmune disease

presents in many ways! (reticular white plaques, mural erythema, erosions)

dx= biopsy 
tx= manage pain/discomfort (corticosteroids, cyclosporines, retinoids)
44
Q

How can you differentiate oral leukoplakia from thrush?

A

white lesions in oral leukoplakia cannot be removed by scraping!

45
Q

What is oral leukoplakia?

A

hyperplasia of squamous epithelium from chronic irritation

precancerous!

can be a/w HPV

46
Q

How are the lesions describes in Erythroplakia?

A

red, velvety plaque-like lesion

47
Q

What do Erythroplakia represent? What must be done?

A

> 90% represent a malignant change

all must be biopsied, refer to ENT

48
Q

What causes Hairy Leukoplakia? What population?

A

EBV

pts with HIV

49
Q

Describe the presentation of Hairy Leukoplakia

A

lateral tongue
white, painless plaque, cannot be scraped

not considered premalignant

50
Q

What are Mucoceles?

how do you treat?

A

fluid filled cavities w/ mucous glands lining the epithelium

  • may rupture spontaneously
  • remove w/ cryotherapy or excision of entire cyst
51
Q

Where are amalgam tattoos seen, indicating not a melanoma?

A

seen adjacent to amalgam filling (metal used in dental fillings)

52
Q

what are torus palatinus?

A

benign boney lesions

normally on hard palate

53
Q

Bacteria that causes dental caries

A

strep mutans

54
Q

What is Sialolithiasis?

Where does it occur most often?

A

stone and/or inflammation within the salivary glands or ducts

stones occur in Wharton duct

55
Q

What are possible sx in a pt with Sialolithiasis?

A
  • acute swelling

- increased pain with eating

56
Q

Tx of Sialolithiasis

A
  • hydrate, heat, massage, “milk” the duct
  • sialagogues
  • nsaids
57
Q

What is suppurative parotitis and what is the clinical presentation?

A

acute infection of parotid gland

  • sudden onset of firm, erythematous swelling or pre/postauricular areas
  • severe pain/tenderness
  • trismus
58
Q

What is the most important thing to be aware of in a pt with possible Ludwig’s angina?

A

Airway compromise!

most common neck space infection( from tooth infection)

59
Q

Most common type of oral cancer?

A

squamous cell carcinoma (>90%)

60
Q

If a pt comes in complaining of oral ulcers or masses that do not seem to heal, what diagnosis should you be thinking of?

A

Squamous cell carcinoma

61
Q

What strains of HPV are a/w SCC of the tongue, tonsil, and pharynx?

A

Types 16, 18, and 31

62
Q

Hoarseness from laryngitis should last how long?

If it lasts longer, what do you do?

A

Hoarseness from laryngitis should last 1-3 weeks

Anything longer than 3 weeks needs to be visualized (laryngoscopy by ENT)

Anything 6 weeks or longer should be consider cancer until proven otherwise

Foundations II (Jess) (8 decks)

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